The template forms found on the attached pages are for use to ensure compliance with the HIPAA privacy rule effective April 14, 2003. Please review these template forms and the accompanying information. You may download the applicable template and customize it to your specific research study prior to its submision to CPHS.

For each study that is currently on-going, at least one of these forms will need to be filled out and approved by CPHS:

• Subject Authorization
  (includes links to both UTHealth and MHHS template authorizations)

• Data Use Agreement/ Limited Data Set

• Waiver of Authorization

• Preparatory to Research

• Research Using Decedent PHI

• Studies Exempt from HIPAA (includes use of de-identified Protected Health Information (PHI) and/or those not obtaining PHI from a covered entity)

If you have any questions regarding HIPAA please call the CPHS HIPAA Officer at 713-500-7943.

UTHealth’s Compliance Hotline (1-888-472-9868)
For other questions, please call us at 713-500-7943.